Hungry shifts, higher risk: Three years on, basic needs still failing too many doctors

It is safe to say that no one wants to be treated by a hungry, burned-out doctor.

“Delivering high quality of care is only possible if staff get the practical and emotional support they need,” stated a briefing by the King’s Fund in August 2024.

That was not the first or only piece on the topic: research has consistently shown the link between issues affecting NHS professionals as individuals and the care that patients receive.

The level of dissatisfaction has been tracked since 2021, when the NHS Staff Survey introduced a ‘Burnout’ sub-score. This is calculated from responses to questions about being ‘frustrated’, ‘exhausted’, and ‘having not enough energy for family and friends during leisure time’.

Though the latest survey recorded a slight improvement, the number of people reporting these feelings still ranges between 29% and 51% across different areas. The percentage for those in the “medical and dental” group is 37.6%.

Burnout has many contributing factors. But at the root of it lie needs that many people take for granted, including access to food — and the opportunity to eat it.

This is acknowledged by a recent NHS Employers awareness campaign, which outlines NHS staff’s wellbeing needs in a pyramid. Nutrition at the base, along with hydration, toilet facilities, sleep, work-life balance and safe working conditions.

In late 2022, a survey of our members revealed that a significant number of doctors were struggling to purchase nutritious meals or snacks during working hours.

Despite efforts to address this, the NHS Staff Survey found that the problem has, albeit marginally, worsened.

The link between hunger, patient safety and compassion

Our 2022 investigation found the problem to be particularly acute amongst young practitioners or junior doctors, now known as resident doctors, typically between 25 and 34 years of age:

• Three in four (77%) have experienced burnout at work.
• More than a third (39%) attributed the lack of access to good food at work as a key contributing factor to burnout.
• Two-thirds (66%) felt patient safety was at risk when they worked while hungry and tired.

“Doing this job and being hungry at the same time is a challenge,” Dr Billy Wilson, an anaesthetist working in the north of England, told us at the time. “When you work in a hospital situation where a wrong decision can have dangerous consequences, then the risk is even greater,” he added.

Dr Mariam Mourad, a paediatrician working in London, agreed on the effect on decision making, but went one step further: “When being so hungry makes you less compassionate towards your patients, then that is a substantial shift in your entire practice of medicine.”

“We must remember that doctors don’t work nine-to-five office hours,” said Dr John Holden, Chief Medical Officer at MDDUS. “They spend extended periods of time in hospital wards and often do not have the chance to leave the hospital or ward to get food.

“A tired doctor is a doctor with increased risk who is more likely to make mistakes. Good food should be a simple prerequisite for doctors going to work or, at least, having facilities available to make food – many tell us they don’t.

“Not even being able to access food from a vending machine is unacceptable; ultimately, patients will suffer.”

Following the MDDUS survey results, our chief executive, Chris Kenny, contacted all chief medical officers across the UK, urging them to prioritise this problem, and wrote to MPs and MSPs across the UK to highlight the critical issue.

Dr Sandesh Gulhane, MSP, raised our survey findings in the Scottish Parliament, calling them “worrying” and “symptomatic of a management culture that does not prioritise frontline healthcare workers.”

Steps towards progress but a challenging reality

Since then, several steps have been taken to address the issue.

The 2022 No Hungry Staff campaign, led by Neely Mozawala and Dr Saliha Mahmood Ahmed, aimed to ensure the 24/7 provision of hot, affordable food for NHS staff and secured an official commitment from the government to include this requirement in the National Standards for healthcare food and drink.

The Standards acknowledge hospitals’ role in becoming places where “staff are nourished and hydrated to deliver optimal and safe clinical care” and state that “employers should make sure staff can access healthy, balanced, hot and cold food options 24/7”.

Yet solving the problem in practice has proven challenging.

A thread in the subreddit r/doctorsUK tells a patchy story in answer to the question “Do any hospitals in the NHS actually provide access to hot food overnight?”.

“Do vending machines with pot noodles count?” asks one user. “Some places will have a 24/7 Costa, which will tick the box. Leicester canteen serves chips and stuff overnight,” says another. “Hot chips on a nightshift would genuinely make me cry with joy at this point,” comes one reply.

Some complain that certain places appear to be circumventing the policy by providing only a few pieces of equipment. “Anywhere I’ve worked there is a kettle and microwave, but you have to bring your own stuff in to use. No vending machines with microwave meals. Canteen closes at 6 or 7,” is one Redditor’s experience.

“My nearest tertiary centre does hot pizzas/paninis up until 2-3 am, which is great, but they are very much the exception locally”, writes a doctor in Glasgow.

Others give testimony of hospitals offering options around the clock. “Definitely been in a few hospitals which have overnight food. One hospital has food (including 12-inch pizzas) until 3 am, which was great. One had food 24 hours, but the food was a bit (rubbish) and expensive.”

Meanwhile, separate threads discuss how difficult it is to simply make the time to eat, highlighting the practical arrangements and cultural changes that are needed for policy to become a reality.

“The proportion of staff saying they can ‘often’ or ‘always’ eat nutritious and affordable food while working is similar to last year at just over half of respondents,” reveals the 2024 NHS Staff Survey.

For medical and dental practitioners, that number has gone up, from 49.69% to 50.06%.

The 10-Year Health Plan for England, launched in July, promises to develop a new set of staff standards that will mandate access to nutritious food and drink for hospital personnel.

Three years on from our survey, too many doctors are still being asked to care for patients without having their own basic needs met.

Access to proper nutrition for doctors is widely recognised as not a matter of convenience, but of safety, compassion and trust in the system.

Progress will mean moving beyond policy mandates to embed a culture where looking after staff is inseparable from looking after patients, a fundamental problem for which MDDUS will continue to raise awareness on behalf of our members.

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This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.